%0 Journal Article
%C Infermi Hospital, Rimini, Italy
%A Andruccioli, Jessica
%A Montesi, Alessandra
%A Raffaeli, William
%A Monterubbianesi, Maria C
%A Turci, Paola
%A Pittureri, Cristina
%A Sarti, Donatella
%A Vignali, Alberto P
%A Rossi, Andrea P
%J J Palliat Med
%D 2007 Jun
%N 3
%P 741-8
%T Illness awareness of patients in hospice: psychological evaluation and perception of family members and medical staff
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592986
%X Background: Despite the widespread belief that patients should be given full information about their disease and prognosis, they actually they know very little. The purpose of this study was to evaluate the awareness of 100 patients (from the Hospices of Rimini and Savignano-Rubicone) about their diagnoses and prognoses. It is also investigated staff and relatives perceptions of patients' awareness. Methods: A semistructured interview of patients was performed by psychologists to evaluate their awareness about diagnosis and prognosis. Then psychologists completed a questionnaire about their own evaluation of patients' disease awareness. Moreover, the same questionnaire was completed by family members and by staff members (doctors and nurses) about their perceptions of patients' awareness. Doctors and nurses gave their answers based on their routine interactions with patients. Results: Despite the fact that patients in hospice were in the terminal phase of disease, 30% of patients had no diagnosis awareness, and an even higher percentage of patients (62%) who had no prognosis awareness

%0 Journal Article
%C Canadian Food Inspection Agency (CFIA), 59 Camelot Drive, Ottawa, Ontario K1A 0Y9. appeltm@inspection.gc.ca
%A Appelt, Martin
%A Sperry, Jennifer
%J Can Vet J
%D 2007 May
%N 5
%P 529-34
%T Stunning and killing cattle humanely and reliably in emergency situations--a comparison between a stunning-only and a stunning and pithing protocol
%V 48
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17542375

%0 Journal Article
%A Barasch, Andrei
%A Coke, John M
%J Periodontol 2000
%D 2007 
%P 44-54
%T Cancer therapeutics: an update on its effects on oral health
%V 44
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17474925

%0 Journal Article
%C Departamento de Endoscopia Digestiva, Hospital Angeles del Pedregal, Mexico, D.F
%A Barinagarrementeria, Ricardo
%J Rev Gastroenterol Mex
%D 2005 Jul
%P 95-106
%T [Update on endoscopic management of malignant obstructive jaundice]
%V 70 Suppl 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469413
%X The diagnosis of bilio-pancreatic diseases is carried out when patients present symptoms of biliary obstruction. The majority of these patients cannot receive curative treatment at the time of the diagnosis. Laboratory tests can differentiate between intra- or extra-hepatic obstruction, and the different imaging techniques will establish the cause and degree of disease extension. Endoscopic cholangiography can confirm the tumor's etiology with a biopsy, cytology or aspiration at the level of the stenosis. Palliative endoscopic treatment offers good results. The decision of placing a plastic or metallic stent will depend on the probable survival rate that the patient has. In tumors in the hila a previous magnetic resonance cholangiography plays a fundamental role in the therapeutic decision

%0 Journal Article
%C Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Mass 02115, USA
%A Bautista-Hernandez, Victor
%A Marx, Gerald R
%A Gauvreau, Kimberlee
%A Pigula, Frank A
%A Bacha, Emile A
%A Mayer, John E Jr
%A del Nido, Pedro J
%J J Thorac Cardiovasc Surg
%D 2007 Jun
%N 6
%P 1540-6
%T Coarctectomy reduces neoaortic arch obstruction in hypoplastic left heart syndrome
%V 133
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17532953
%X OBJECTIVE: Neoaortic arch obstruction after stage I palliation is an important risk factor affecting interstage mortality in patients with hypoplastic left heart syndrome, with no accepted standard surgical approach. We sought to determine the efficacy of different techniques for aortic arch reconstruction to reduce the incidence of postoperative neoaortic arch obstruction. METHODS: From January 2000 through June 2005, 210 patients underwent stage I palliation. To enlarge the aortic arch, 12 (6%) patients had a direct connection, 115 (55%) patients had an aortic homograft, 53 (25%) patients had a pulmonary homograft patch, and 30 (14%) patients had autologous pericardium. Independent of the technique for aortic enlargement, 55 (26%) children had coarctectomy. RESULTS: Eighty patients had a significant arch gradient, as determined by means of echocardiography, and of these, 50 required balloon angioplasty, surgical arch augmentation, or both. Preoperative aortic coarctation was consistently linked to neoaortic arch obstruction (P = .032). Patients having aortic arch enlargement by means of direct connection or with autologous pericardium were less likely to have neoaortic arch obstruction (P = .049). Coarctectomy resulted in a lower incidence of neoaortic arch obstruction, as determined by means of echocardiography (P = .015), or need for reintervention (P = .01). CONCLUSIONS: Patients with hypoplastic left heart syndrome undergoing aortic arch enlargement with autologous tissue are less likely to require intervention for neoaortic arch obstruction compared with those having homograft patch reconstruction. Excision of all ductal tissue by means of coarctectomy reduces the risk of recurrent aortic arch obstruction. An aggressive approach to reconstruction of the arch and the use of autologous tissue at the time of stage I palliation is advocated

%0 Journal Article
%C Palliative Care Program, Cedars-Sinai Medical Center, Los Angeles, California
%A Bharadwaj, Parag
%A Vidyasagar, M S
%A Kakria, Anjali
%A Tanvir Alam, U A
%J J Palliat Med
%D 2007 Jun
%N 3
%P 654-7
%T Survey of Palliative Care Concepts among Medical Interns in India
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592975
%X Background: Medical knowledge, if theoretical, will fade away if not reinforced especially if not clinically implemented. We conducted a survey study amongst interns to assess awareness and confidence of common palliative care issues. Undergraduate medical education in India is a 4(1/2) -year course. This is followed by a 1-year internship before the new physician can practice independently. Aim: To compare the level of awareness in palliative care concepts among interns to that of final-year medical students at Kasturba Medical College, Manipal, India. Materials and Methods: Forty-four interns participated in a survey study. The data were collected after the survey and the responses were analyzed. We compared these data with those obtained from conducting the same survey among medical students. Results: The reported theoretical knowledge of palliative care concepts was better than the level of confidence in performing practical aspects of palliative care. The interns, overall, did not out-perform the students. Conclusion: Before this survey, we hypothesized that interns in India would have low levels of self-reported understanding of palliative care and its components. We were hoping to see an improvement in knowledge and confidence with training. In contrast, there was not much of an improvement but rather a decline in some areas. From this, we conclude that when medical students become interns, they need reinforcement of knowledge and more hands-on experience

%0 Journal Article
%C Palliative Care Program, Cedars-Sinai Medical Center, Los Angeles, California
%A Bharadwaj, Parag
%A Vidyasagar, M S
%A Kakria, Anjali
%A Tanvir Alam, U A
%J J Palliat Med
%D 2007 Jun
%N 3
%P 651-3
%T Survey of Palliative Care Concepts among Medical Students in India
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592974
%X Background: Students must develop a "tension for change" before new material is learned. Therefore, a needs assessment generally precedes curriculum change in order to identify what the target population thinks they already know about a subject. Undergraduate medical education in India is a 4(1/2) -year course. This is followed by a 1-year internship before the new physician can practice independently. Aim: To assess the level of awareness in palliative care concepts among final-year students at Kasturba Medical College, Manipal, India. Materials and Methods: One hundred eleven final-year students participated in a survey study 6 months before graduation. The data were collected after the survey and the responses were analyzed. Results: The reported theoretical knowledge of palliative care concepts was better than the level of confidence in performing practical aspects of palliative care. Conclusion: Before this survey, we hypothesized that medical students in India would have low levels of self-reported understanding of palliative care and its components. In contrast, they reported a high level of understanding of palliative care but very little understanding and confidence in performing the associated skills. From this, we conclude that these medical students are ready for instruction in the practical skills of palliative care

%0 Journal Article
%A Bonanno, George A
%A Boerner, Kathrin
%J JAMA
%D 2007 Jun
%N 24
%P 2693; author reply 2693-4
%T The stage theory of grief
%V 297
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17595267

%0 Journal Article
%C School of Nursing, University of Texas Health Science Center, Houston, TX, USA. amy.o.calvin@uth.tmc.edu
%A Calvin, Amy O
%A Kite-Powell, Dorothy M
%A Hickey, Joanne V
%J J Neurosci Nurs
%D 2007 Jun
%N 3
%P 143-50
%T The neuroscience ICU nurse's perceptions about end-of-life care
%V 39
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17591410
%X The purpose of this qualitative descriptive study was to describe neuroscience intensive care unit (NICU) nurses' perceptions regarding their roles and responsibilities in the decision-making process during the change in intensity of care and end-of-life care for patients. Twelve NICU nurses agreed to a private moderately structured interview. Three major themes summarize the data: (1) providing guidance, (2) being positioned in the middle of the communication process, and (3) feeling the emotions of patients and families. The nurse caring for a patient at the end of life provides guidance from the middle or "hub" of the communication process between family members and physicians. The nurses in this study describe an array of feelings associated with this role. This research adds to the limited body of knowledge concerning critical care nurses' experiences with end-of-life care. Providing guidance and being in the middle of the communication process can be a lonely, challenging, yet rewarding position. Results of this study provide a basis for offering emotional support to NICU nurses who care for patients at the end of life

%0 Journal Article
%C Pain Management Research and Education, Bournemouth University
%A Carr, Eloise
%J J Perioper Pract
%D 2007 May
%N 5
%P 200-3, 206-8
%T Barriers to effective pain management
%V 17
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17542389
%X In this article my sole aim is to engage the reader to think about the management of pain in a different way. I have deliberately taken a less formal style but provided references if you are interested in following up. The management of pain has often been assumed to be a routine part of care, in fact in the perioperative arena it is the second most common nursing intervention (Juntilla et al 2005). Despite this activity, pain after surgery has been reported to be a consistent problem which has spanned several decades (Marks & Sachar 1973, Wu et al 2002, Ekstein et al 2006). The reasons for this are well documented and include: patient barriers, inadequate knowledge of healthcare professionals, lack of assessment and organisational practices which impede the administration of analgesics and non-pharmacological interventions. Despite this knowledge the changes required in practice are not necessarily forthcoming. The purpose of this paper is to explore the patient, professional and organisational barriers which affect the optimal management of pain in the perioperative period, and provide some practical solutions to help you think about and manage pain more effectively

%0 Journal Article
%C Royal College of Nursing, London. chris.chaloner@rcn.org.uk
%A Chaloner, C
%A Sanders, K
%J Nurs Stand
%D 2007 May
%N 36
%P 42-6
%T Euthanasia: the legal issues
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17549975
%X The legal status of euthanasia is frequently deliberated. It remains unlawful in Britain and advocates for a change in the law are vigorously opposed by those who argue that it should remain unchanged. An objective account, in which current law and arguments for and against change are exposed, is essential to inform the euthanasia debate. In this article the legal issues concerning euthanasia are examined and arguments raised by proposed changes in the law are considered

%0 Journal Article
%C DIPEx, Department of Primary Health Care, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK. alison.chapple@dphpc.ox.ac.uk
%A Chapple, A
%A Ziebland, S
%A McPherson, A
%A Herxheimer, A
%J J Med Ethics
%D 2006 Dec
%N 12
%P 706-10
%T What people close to death say about euthanasia and assisted suicide: a qualitative study
%V 32
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17145910
%X OBJECTIVE: To explore the experiences of people with a "terminal illness", focusing on the patients' perspective of euthanasia and assisted suicide. METHOD: A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a "terminal" illness, malignant or non-malignant. RESULTS: That UK law should be changed to allow assisted suicide or voluntary euthanasia was felt strongly by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse. CONCLUSION: Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death

%0 Journal Article
%C Department of Clinical and Surgical Sciences (Surgery), University of Edinburgh, Royal Infirmary, Edinburgh EH16 4SA, UK
%A Connor, S
%A Barron, E
%A Redhead, D N
%A Ireland, H
%A Madhavan, K K
%A Parks, R W
%A Garden, O J
%J Eur J Surg Oncol
%D 2007 Apr
%N 3
%P 341-5
%T Palliation for suspected unresectable hilar cholangiocarcinoma
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17175127
%X AIM: The aim of this study was to evaluate the outcome of different techniques of palliation for patients with hilar cholangiocarcinoma. METHOD: All patients treated with palliative intent between 1988 and 2004 at the Royal Infirmary of Edinburgh were reviewed. Patients were analysed on an intention to treat basis. Demographics, procedure and outcome (including re-admissions) were recorded. RESULTS: Two hundred and thirty-three patients underwent palliative treatment for suspected hilar cholangiocarcinoma. The diagnosis was confirmed histologically in 109 patients. The procedure related morbidity and mortality was 54/225 and 18/207 respectively. Seventy-one patients required re-admission. Twenty patients underwent surgical biliary bypass for jaundice. Those undergoing surgical palliation had a longer median (95% CI) time to re-admission (16 (0-36) vs.7 (2-12) weeks, p=0.001). Endoscopic retrograde cholangio-pancreatography (ERCP) and stenting was only successful in 28 patients and was associated with a significantly higher re-admission rate compared to patients in whom ERCP was not performed (60/179 vs. 4/27, p=0.050). The overall median (95% CI) survival was 145 (124-185) days. CONCLUSION: Current options for palliation of hilar cholangiocarcinoma provide good short term success but are all associated with significant early and late morbidity. Due to its low success and association with an increased re-admission rate, ERCP for definitive palliation should not be used in the first line staging and management of these patients

%0 Journal Article
%C National Hospice and Palliative Care Organization (S.R.C., C.S.), Alexandria, Virginia; and Department of Health Care Policy (F.E., N.A.C.), Harvard Medical School, Boston, Massachusetts, USA
%A Connor, SR
%A Elwert, F
%A Spence, C
%A Christakis, NA
%J J Pain Symptom Manage
%D 2007 Jun
%T Geographic Variation in Hospice Use in the United States in 2002
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17590566
%X Complete Center for Disease Control death certificate records and Centers for Medicare and Medicaid Services 100% Standard Analytic File for hospice claims for 2002 were used to describe the whole population of hospice users and nonusers in the United States. The overall hospice utilization rate for persons 65 years and older was 28.6%. Hospice utilization varied by cause of death, and was highest for individuals with malignancies (65%), kidney disease and nephritis (55%), and Alzheimer's disease (41%). Hospice utilization was lowest for conditions leading to rapid or unexpected death, such as accidents and suicide (0%), influenza and pneumonia (3%), and sepsis (6%). Considerable geographic differences in hospice utilization existed with hospice use higher in the South and the Southwest and lower in the Midwest and the Northeast. State-specific usage rates range from 8% in Alaska to 49% in Arizona. Our findings highlight opportunities for the hospice industry to provide more care, opportunities defined by diagnostic and geographic axes

%0 Journal Article
%C Clinical Benchmarking, University HealthSystem Consortium, 2001 Spring Road, Suite 700, Oak Brook, IL 60532. cuny@uhc.edu
%A Cuny, Joanne
%A Cassel, J Brian
%A Maxwell, Terri L
%A Coyne, Patrick J
%A Usher, Barbara M
%A Amin, Alpesh
%A Twaddle, Martha L
%J J Palliat Med
%D 2007 Jun
%N 3
%P 638-40
%T Response to Carlson/Morrison Guest Editorial: "Evaluating Palliative Care Programs: Let's Do It Right"
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592970

%0 Journal Article
%C Roswell Park Cancer Institute, Elm and Carlton Sts., Buffalo, NY 14263-0001, USA. myron.czuczman@roswellpark.org
%A Czuczman, Myron S
%J Hematology Am Soc Hematol Educ Program
%D 2006 
%P 303-10
%T Controversies in follicular lymphoma: "who, what, when, where, and why?" (not necessarily in that order!)
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17124076
%X Follicular lymphoma (FL) is the most common subtype of indolent lymphoma. Specific "facts" about FL that were generated by past research and have been passed down as dogma to a majority of practicing oncologists over the past 20 to 30 years that need to be revisited, include: (1) do not initiate therapy soon after diagnosis in asymptomatic, advanced-stage patients since it does not change outcome; (2) initiate therapy with single-agent oral alkylators when intervention needed and "save" more aggressive combination chemotherapy for "later" since the standard chemotherapy regimen used did not seem to impact survival; (3) FL is an incurable disease and palliation of symptoms was an acceptable approach to the expected pattern of repeated relapses; (4) transformation of FL is independent of the type or timing of therapies received by a patient; (5) median overall survival (OS) for FL patients is 8-10 years. Although the heterogeneity of FL will never change, we are developing the scientific tools to identify and better understand the biologic and genetic features associated with its clinical variability. In the current exciting era of targeted therapies (e.g., rituximab, radioimmunoconjugates) and novel treatment approaches demonstrating an improvement in treatment outcomes (e.g., disease-free survival and OS), our old beliefs and historically accepted dogma need to be retested and revitalized. The optimal combination(s) of old and new agents and the optimal timing of when to initiate and how to sequence specific therapies will require data from well-designed clinical trials that should include important correlative laboratory studies

%0 Journal Article
%C Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
%A Deep, Kristy S
%A Green, Sharon F
%A Griffith, Charles H
%A Wilson, John F
%J J Palliat Med
%D 2007 Jun
%N 3
%P 712-20
%T Medical residents' perspectives on discussions of advanced directives: can prior experience affect how they approach patients?
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592983
%X Introduction: Resident physicians are inadequately taught how to communicate with patients about end-of-life decision making. Their beliefs about resuscitation and prior experiences with end-of-life care may impact the manner in which they approach patients. Objective: To explore residents' perceptions of end-of-life discussions, determine the features they find most important, and discern the challenges they face in this process. Methods: Internal medicine residents were surveyed about their experiences discussing resuscitation with patients including perceptions of patient understanding, outcomes of resuscitation, and regret about attempting to resuscitate patients. They were asked what features of these discussions are most important and which are the most challenging. Qualitative content analysis was used to examine the responses to open-ended questions. Results: Fifty-five residents completed the survey. Residents reported rarely feeling satisfied with the results of these discussions and disagreed with the decision for resuscitation numerous times. They perceive that few patients and families understand resuscitation. In their description of important features, they focus on the content of the discussion rather than the process, with the most common responses centering on a description of resuscitation. In contrast, the greatest challenge they identify is dealing with the emotional aspects of the discussion. Conclusions: Residents report internal conflict about their experiences discussing resuscitation with patients. Their approach to these discussions focuses on resuscitation itself with less attention paid to processes that might improve patient decision making. The challenges they describe may be overcome with improved education about end-of-life communication

%0 Journal Article
%C Penn State Hershey, Department of Health Evaluation Sciences, The Milton S. Hershey Medical Center College of Medicine, Hershey, Pennsylvania
%A Desharnais, Susan
%A Carter, Rickey E
%A Hennessy, Winnie
%A Kurent, Jerome E
%A Carter, Cindy
%J J Palliat Med
%D 2007 Jun
%N 3
%P 728-40
%T Lack of Concordance between Physician and Patient: Reports on End-of-Life Care Discussions
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592985
%X Objective: To study the effectiveness of patient physician communications regarding health care choices at the end of life. We studied communications occurring between physicians and their patients who had either terminal cancer or congestive heart failure, with less than 6 months to live. Methods: This pilot study used in-person interviews with 22 physicians and 71 of their (matched) patients. Subjects provided paired responses to questions regarding their conversations related to end-of-life care, including resources, attitudes, and preferences. We calculated the concordance of patient and physician reports about these discussions. We examined the physicians' and the patients' agreement on the patient's diagnosis, and on whether a variety of care options were discussed. We then measured whether physicians' were aware of their patients' preferences for pain management and for place of death. Finally, we measured physicians' knowledge of whether religious/spiritual concerns or financial concerns had affected their patients' decisions regarding end-of-life care. Both bivariate and multivariate models were used. Results: As a whole, the concordance scores were poor; however, concordance varied across domains of issues discussed. Patients with less education had significantly lower concordance scores. Discussion: We have identified domains in which the physicians and patients may be least effective in discussing end-of-life care options. Findings may help in designing interventions to improve communication, especially for patients with less education

%0 Journal Article
%C Division of Education and Research, Duluth Clinic, Duluth, Minnesota., University of Minnesota Medical School Duluth, Duluth, Minnesota
%A Elliott, Thomas E
%A Palcher, Jeanette A
%J J Palliat Med
%D 2007 Jun
%N 3
%P 696-704
%T The prognostic value of measuring health-related quality of life in hospice patients
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592981
%X Purpose: Better prognostic instruments are sorely needed for patients near the end of life. Health-related quality of life instruments designed for hospice patients have not been previously studied for their prognostic properties. This study evaluated the prognostic property of the Missoula-Vitas Quality of Life Index (MVQOLI) with hospice patients. Methods: A prospective, cross-sectional cohort design included all consecutive patients admitted to a hospice over a 19-month period. At admission to hospice, patients were asked to complete an MVQOLI. In addition, hospice nurses completed three functional status instruments. All patients were followed until death, study closure, or loss to follow-up. Results: The sample included 1047 patients, but only 231 (22%) were able to complete an MVQOLI at admission. Functional status data were collected on nearly all of the patients. The Karnofsky performance score, modified activity of daily living score, and descriptive symptom score were significantly associated with survival time. Using Cox regression models these functional status assessments were strongly associated with survival time (p < 0.001). However, the MVQOLI scores were not significantly associated with survival time, except for the function subscale (p = 0.045). Conclusion: The MVQOLI global, total, and four of the five weighted-domain baseline scores were not associated with survival time in hospice patients. Other methods for prognostication at the end of life are needed

%0 Journal Article
%C Dr. Ellman is assistant professor of medicine and director, End-of-Life Care Training for Medical Students, Yale University School of Medicine, New Haven, Connecticut. Dr. Rosenbaum is assistant professor of medicine, Yale University School of Medicine, New Haven, Connecticut, and Waterbury Hospital Health Center, Waterbury, Connecticut. Dr. Bia is professor of medicine and director, Clinical Skills Program, Yale University School of Medicine, New Haven, Connecticut
%A Ellman, MS
%A Rosenbaum, JR
%A Bia, M
%J Acad Med
%D 2007 Jul
%N 7
%P 723-727
%T Development and Implementation of an Innovative Ward-Based Program to Help Medical Students Acquire End-of-Life Care Experience
%V 82
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17595576
%X The authors developed and implemented a new ward-based end-of-life care experience for third-year medical students at Yale University School of Medicine, which began on a pilot basis in 2005. The primary objectives of the program, which still continues, are to improve students' comfort and skills in communicating with and assessing patients facing the end of life and to reflect on their experiences. Students interview a hospitalized patient, family, and caregivers; assess specified end-of-life domains and management plans; reflect on the experience; and then prepare a report for presentation at a case conference facilitated by dedicated multidisciplinary faculty. Many students interview patients while rotating on psychiatry consults, and the case conference occurs during the psychiatry clerkship. A total of 45 students in the pilot year (2005), 76 students in the following year, and 48 thus far in the current year have completed the program. An assessment of the personal impact of the exercise on the students who completed the program in 2005 and 2006 revealed six themes, including students' recognition of the complexity of patients' reactions to dying, students' appreciation of the value of the clinicians' presence, and students' personal reflections. This experience suggests that a hands-on end-of-life exercise is feasible and will be well received in the acute inpatient setting. Key features for success include separate, dedicated faculty for the case conference (which is integrated into a single clerkship), emphasis on student self-reflection, and a requirement that the written component become part of the student's portfolio

%0 Journal Article
%C Service d'anesthesie-reanimation, groupe hospitalier Albert-Chenevier/Henri-Mondor, AH-HP, Creteil. edouard.ferrand@hmn.aphop-paris.fr
%A Ferrand, Edouard
%A Benhamou-Jantelet, Ghislaine
%J Soins
%D 2007 Apr
%N 714
%P 43-5
%T [Ethics and resuscitation, limits and cessation of therapy]
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17533924

%0 Journal Article
%C The Pediatric Advanced Care Team, General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa 19104, USA. feudtner@email.chop.edu
%A Feudtner, Chris
%A Feinstein, James A
%A Satchell, Marlon
%A Zhao, Huaqing
%A Kang, Tammy I
%J JAMA
%D 2007 Jun
%N 24
%P 2725-32
%T Shifting place of death among children with complex chronic conditions in the United States, 1989-2003
%V 297
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17595273
%X CONTEXT: The place where children with complex chronic conditions are dying may be shifting toward residential homes due to the evolving epidemiology of life-threatening childhood conditions, advances in home-based medical technology, and changes in attitudes about pediatric palliative care and hospice services. OBJECTIVES: To determine whether pediatric deaths attributed to complex chronic conditions are increasingly occurring in the home and to assess race and ethnicity disparities in the location of death. DESIGN, SETTING, AND PARTICIPANTS: Retrospective national-level case series drawn from the National Center for Health Statistics' Multiple Cause of Death Files spanning 1989-2003. Participants included all deceased individuals aged 19 years or younger with a complex chronic condition excluding injury and noncomplex chronic conditions (as classified by International Classification of Diseases, Ninth Revision or International Classification of Diseases, Tenth Revision). MAIN OUTCOME MEASURE: Place where death occurred. RESULTS: Among the 22.1% of deaths (198 160 of 896 509 total deaths) attributed to a complex chronic condition between 1989 and 2003, the percentage of individuals dying at home increased significantly (P<.001) over time for infants (aged <1 year) (4.9% in 1989 and 7.3% in 2003); 1- to 9-year-olds (17.9% and 30.7%); and for 10- to 19-year-olds (18.4% and 32.2%). Adjusting for decedent characteristics, the odds of dying at home increased significantly each year (odds ratio, 1.04; 95% confidence interval, 1.03-1.04) and were reduced among both black and Hispanic decedents (odds ratio, 0.50; 95% confidence interval, 0.48-0.52 and odds ratio, 0.52; 95% confidence interval, 0.50-0.54, respectively) compared with white decedents. CONCLUSIONS: Children who die with underlying complex chronic conditions increasingly are dying at home. Racial and ethnic disparities regarding place of death may represent important limitations and opportunities for improvement in the current systems of pediatric chronic and palliative care

%0 Journal Article
%A Frkovic, Aleksandra
%A Boskovic, Zvonimir
%J Acta Med Croatica
%D 2007 Apr
%N 2
%P 133-9
%T [Palliative care as a response to dysthanasia]
%V 61
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17585467
%X Palliative care is frequently discussed as an alternative or a counter-balance to euthanasia. In this paper, palliative care is considered as a response to dysthanasia or therapeutic persistence. First, the main features of dysthanasia are mentioned: the accent is put on different questions: until when to implement therapeutic persistence? When does the treatment become useless? What is a permanent vegetative condition? Then, palliative care, the scope of which is to achieve the best life quality for the patient and his family is discussed. The hospice and its care are emphasized, analyzing the international guidelines on the topics at the end of life. International palliative care recommendations are analyzed; special attention is paid on the codex of medical ethics and deontology and its regulations concerning palliative care. Conclusion summarizes some thoughts about dysthanasia and palliative care

%0 Journal Article
%C Faculty of Health, London South Bank University
%A Fullbrook, Suzanne
%A Sanders, Karen
%J Br J Nurs
%D 2007 May
%N 9
%P 538-9
%T Consent and capacity: other aspects of the Mental Capacity Act
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17551445
%X This article concentrates on elements of the Mental Capacity Act that may be glossed over when people are concentrating on the issue of living wills (advanced directives). New powers have been introduced under the Act and these do have the power to alter people's lives. A 'lasting power of attorney', for example, now has the power to take decisions relating to a person's health issues or welfare. There is a new court - the Court of Protection, designed to settle disputes about the validity or applicability of a living will. With the powers of a High Court, the Act reveals the seriousness with which the law now regards the issues that surround the making of a living will and the granting or refusal to grant consent to treatment and care

%0 Journal Article
%C Bar-Ilan University, Tel-Aviv, Israel
%A Gamliel, T
%J Soc Sci Med
%D 2007 Jun
%T "Wailing Lore" in a Yemenite-Israeli community: Bereavement, expertise, and therapy
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17587475
%X This study explores Yemenite-Jewish wailing as an example of how a traditional community copes with bereavement in contemporary Israel. Observations of wailing events and interviews with Yemenite-Israeli wailers and mourners are analyzed in order to understand the respondents' perceptions of wailing as a psychotherapeutic expertise and experience. These findings are further used to substantiate a theoretical reconsideration of models of bereavement, exploring the interplay between the modern, self-centered, and detached psychological model (the "clinical lore") and the traditional, other-oriented, and continuous anthropological model (the "wailing lore"). The article concludes by discussing criticisms of the Western psychotherapeutic paradigm as it relates to bereavement and asking where a mourning ritual such as wailing fits into our understanding of the subjective experiences of grief

%0 Journal Article
%C Epidemiologia dei tumori, ASO S. Giovanni Battista e CPO Piemonte, Torino
%A Gelormino, Elena
%A Pagano, Eva
%A Appiano, Silvana
%A Ceccarelli, Manuela
%A Ciuffreda, Libero
%A Comandone, Alessandro
%A Farina, Enzo
%A Merletti, Franco
%A Mussa, Antonio
%A Penna, Angelo
%A Ponti, Antonio
%A Raciti, Ida
%A Scagliotti, Giorgio Vittorio
%A Segnan, Nereo
%A Senore, Carlo
%A Sismondi, Piero
%A Vineis, Paolo
%A Bertetto, Oscar
%A Ciccone, Giovannino
%J Epidemiol Prev
%D 2007 Jan-Feb
%N 1
%P 25-33
%T [Adapting clinical practice guidelines to a regional oncology network: the Piedmont experience]
%V 31
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17591401
%X OBJECTIVE: To develop a method for adapting the best available cancer practice guidelines (CPGs) to the regional oncology network in Piedmont (NW of Italy, with about 4.3 million residents). METHODS: Four CPG were developed by multidisciplinary working groups, involving local opinion leaders, coordinated by the same team (including epidemiologists and health economists). The major features of these guidelines were: (a) to cover all the phases ofthe disease (from diagnosis to palliative care); (b) to satisfy common standards for evidence based guidelines; (c) to be coherent with the local health organization and resource availability. In the first three CPGs, regarding common cancers (colon-rectum, breast, lung), recommendations were graded according to the underlying level of evidence, from A to C, and treatment was organized by specialty. In the last guideline, regarding a rare condition (soft tissue sarcomas, STS), a grading system reflecting also the clinical importance of the decision was adopted and treatment recommendations were organized by clinical scenarios. In each guideline, some implementation tools, including a set of process and outcome indicators for audit monitoring, were provided. RESULTS: The four CPGs have been published between 2001 and 2004. The number ofrecommendations ranged between 38 (STS) and 103 (colon-rectum), with some differences in the distribution by specialty and grading. The CPGs have been disseminated through the oncology network and local health coordinators have been involved in the implementation. The impact of the CPGs is being evaluated by different approaches (analyses of administrative data, sample surveys and user's interviews). CONCLUSIONS: To adapt evidence based guidelines to a specific regional health organization is feasible and may be usefil for diseases requiring a multidisciplinary approach and continuity of care

%0 Journal Article
%A Gerber, Lois
%J Nursing
%D 2007 Mar
%N 3
%P 42-3
%T Blind faith
%V 37
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17546782

%0 Journal Article
%C Deborah Grassman, ARNP, MSN, is Hospice Coordinator, Bay Pines VA Medical Center, St. Petersburg, Florida. Deborah has pioneered identifying the unique experience of veterans at end of life
%A Grassman, Deborah
%J Home Healthc Nurse
%D 2007 May
%N 5
%P 299-304
%T Wounded warriors: their last battle
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17495557

%0 Journal Article
%C Division of Medical Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. grothey.axel@mayo.edu
%A Grothey, Axel
%A Marshall, John L
%J Oncology (Williston Park)
%D 2007 Apr
%N 5
%P 553-64, 566; discussion 566-8, 577-8
%T Optimizing palliative treatment of metastatic colorectal cancer in the era of biologic therapy
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17536342
%X Over the past decade, new cytotoxic and biologic therapies beyond the old standard-of-care, biomodulated fluorouracil (5-FU), have become available for the treatment of metastatic colorectal cancer (mCRC). The introductions of irinotecan (Camptosar), oxaliplatin (Eloxatin), and bevacizumab (Avastin) have prolonged survival, but the optimal use of these new therapies remains to be determined. Issues remain regarding management of toxicities, treatment of elderly patients or those with poor performance status, and the duration of treatment with front-line therapy. This article reviews recent and ongoing studies of newer therapies in an effort to determine the best use of these drugs in the treatment of mCRC. Current data support the front-line use of bevacizumab added to either 5-FU/leucovorin alone or 5-FU/leucovorin in combination with oxaliplatin (FOLFOX/bevacizumab) or irinotecan (FOLFIRI/bevacizumab). If oxaliplatin is used in first-line therapy, oxaliplatin should be discontinued before the development of severe neurotoxicity and be reintroduced or replaced with irinotecan on disease progression. Definitive conclusions on the sequence and duration of front-line therapy and the most effective strategy to ameliorate toxicity await results of ongoing prospective clinical trials

%0 Journal Article
%C Government Accountability Office, Washington, DC, USA. sara-imhof@hotmail.com
%A Imhof, Sara L
%A Kaskie, Brian
%A Wyatt, Matthew G
%J J Gerontol Nurs
%D 2007 Jun
%N 6
%P 40-9
%T Finding the way to a better death: an evaluation of palliative care referral tools
%V 33
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17598626
%X The authors of this study sought to identify a tool for assessing and referring dying inpatients to palliative care. Six currently available tools were evaluated to determine how well each tool incorporated 16 clinical criteria that indicate the need for palliative care. Scientific evidence supporting each instrument and the tools' ease of use at patients' bedside also was assessed. Results showed none of the tools incorporated all 16 clinical criteria, empirical evaluations were available for only two of the tools, and ease of use varied considerably. Directions for future research were discussed. Nurses working with critically and terminally ill inpatients should consider applying one or more of the current tools to facilitate access to palliative care

%0 Journal Article
%C Skola narodnog zdravlja Andrija Stampar, Medicinski fakultet Sveucilista u Zagrebu, Zagreb, Hrvatska
%A Jovanovic, Aleksandar
%A Jurkovic, Ljiljanka
%A Zlata, Ozvacic
%A Gluhak, Ines
%A Soldo, Dragan
%J Acta Med Croatica
%D 2007 Feb
%N 1
%P 63-8
%T [Care for terminal cancer patients at general practitioner office]
%V 61
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17593643
%X The final goal of palliative care is symptom relief and improving the quality of life. Around 70% of cencer patients suffer pain. Therapy and care provided for dying cancer patients by general practitioners at Dugave-Travno GP Office were investigated. Medical records of 70 cancer patients were collected and analyzed. Sixty-seven patients had died. A total of 76 cancers at 22 various sites were diagnosed. There were 79 associated diseases diagnosed in 44 patients, along 43 diseases related to malignant disease in 26 patients. Physicians provided home nursing for 30 patients. In 66 cases family provided support. Physicians collaborated with community health nurses in 38 cases. A total of 66 patients were using analgesic therapy, 37 patients continuously, and 48 patients for up to one year. In 56 patients analgesic drugs were administered orally, in 25 parenterally, in 16 rectally, and in 21 patients transdermally. Physicians prescribed opioid therapy in 55 patients: codeine in 2, tramadol in 46, pentazocine in 7, methadone in 5, Kapanol in 15 and fentanyl in 21 patients. Sixty patients received adjuvant drug therapy. A total of 59 patients were hospitalized in terminal stage of the disease. Study results showed a high rate of associated diseases and diseases related to malignant disease in cancer patients. The collaboration between general practitioners and family members was satisfactory. Community health services should be improved, and the World Health Organization guidelines on palliative care, management of malignant pain in particular, should be more thoroughly followed

%0 Journal Article
%C Department of Psychology, Rhodes University, Grahamstown 6140, South Africa. z.knight@ru.ac.za
%A Knight, Zelda G
%J Psychoanal Rev
%D 2007 Apr
%N 2
%P 277-89
%T The analyst's emotional surrender
%V 94
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17408347

%0 Journal Article
%C Servicio de Gastroenterologia, Centro Medico Virginia Mason, Seattle, Washington 98101, USA. gasrak@vmmc.org
%A Kozarek, Richard A
%J Rev Gastroenterol Mex
%D 2005 Jul
%P 141-8
%T [Self-expandable metal stents in the GI tract]
%V 70 Suppl 1
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17469417
%X Self-expandable metal Stents (SEMS), first introduced in the late 90s for the palliation of malignant obstructive jaundice and unresectable esophageal malignancy, are now being variably placed for high risk surgical patients in the setting of malignant gastric outlet and colon obstruction. This review attempts to place SEMS into perspective with respect to surgery and other palliative modalities when treating a variety of GI malignancies and attempts to define the role, if any, of SEMS placement in patients with refractory benign GI stenoses

%0 Journal Article
%C Division of Nephrology, University Health Network, Toronto, Canada
%A Li, Marilyn
%A Porter, Eveline
%A Lam, Robert
%A Jassal, Sarbjit V
%J Am J Kidney Dis
%D 2007 Jul
%N 1
%P 90-7
%T Quality improvement through the introduction of interdisciplinary geriatric hemodialysis rehabilitation care
%V 50
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17591528
%X BACKGROUND: Provision of rehabilitation with the aim of restoring personal independence in elderly hemodialysis patients faces several challenges. DESIGN: Quality improvement report. SETTING & PARTICIPANTS: First 3 years of experience of an inpatient geriatric hemodialysis rehabilitation program in Toronto. Patients with new-onset disability from prolonged illness or an acute event rendering them incapable of living independently. QUALITY IMPROVEMENT PLAN: Provision of in-patient rehabilitation with on-site dialysis; a simplified referral system; preferential admission of elderly dialysis patients; short daily dialysis sessions; integrated multidisciplinary care by experts in rehabilitation, geriatric medicine, and nephrology; and reciprocal continued medical education among staff. MEASURES: Outcome measures were percentage of patients discharged home, score on the Functional Independence Measure, and attainment of rehabilitation goals. RESULTS: In the first 36 months, 164 dialysis patients aged 74.5 ± 7.8 years were admitted. On admission, patients had a mean Charlson comorbidity score of 7.8 ± 2.5, 98% had difficulty walking, and 84% required help with bed-to-chair transfers. After a median of 48.5 days, 111 patients (69%) were discharged home; 15 patients (9%), to an assisted-living setting; 20 patients (12%), to a long-term care facility; and 18 patients (11%), to other facilities for acute or palliative care. Of those completing therapy, 82% met some or all of their rehabilitation goals. LIMITATIONS: The program relied on the leadership and drive of key personnel. Discharge disposition as an outcome can be affected by many factors, and definition of attainment of rehabilitation goals is arbitrary. CONCLUSION: The introduction of an integrated dialysis rehabilitation service can help older dialysis patients with new-onset functional decline return to their home

%0 Journal Article
%C Department of Counselling Psychology, OISE/University of Toronto, Toronto, Ontario, Canada., Department of Psychology, Baycrest Centre, Toronto, Ontario, Canada
%A Mackenzie, Corey S
%A Smith, Marilyn C
%A Hasher, Lynn
%A Leach, Larry
%A Behl, Pearl
%J J Palliat Med
%D 2007 Jun
%N 3
%P 749-58
%T Cognitive Functioning under Stress: Evidence from Informal Caregivers of Palliative Patients
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592987
%X Background: Caring for a terminally ill family member can be extremely stressful, and stress is known to have a negative influence on aspects of cognition. In contrast to the well-known physical and mental health risks associated with caregiving, little is known about its impact on cognitive functioning. Objective: The primary objective of this study was to explore cognition among caregivers of palliative family members with a battery of neuropsychological tests. A secondary objective was to examine changes in cognition following caregiving by retesting a subset of participants at least 6 months after the death of their care recipient. Method: While caregiving, 27 participants completed an assessment battery measuring attention, learning, and memory, as well as intelligence, mood, and general health; 22 participants completed this battery again post-caregiving. We compared caregivers' cognitive performance to healthy normative samples. Results: Participants who were caring for palliative relatives exhibited significant impairments in attention, including difficulty monitoring their performance and regulating their attentional resources. In contrast, participants' episodic and working memory performance was not impaired while caregiving. A mixed pattern of improvement and worsening of cognitive functioning was evident among caregivers retested after their family member's death. Conclusions: In addition to the well-documented physical and mental health risks associated with caregiving, this study adds to a small body of literature demonstrating impaired cognitive functioning among family members providing end-of-life care. Secondary findings of both improvement and deterioration of cognition post caregiving provide tentative support for the possibility of reversing certain cognitive deficits by reducing caregiver stress

%0 Journal Article
%A Martinez Gonzalez, C
%J An Pediatr (Barc)
%D 2007 Jan
%N 1
%P 87-8; author reply 88
%T [Survey on ethics in Spanish pediatric intensive care units. Lights and shadows]
%V 66
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17266859

%0 Journal Article
%C Rampark Pain Centre, Lurgan, Northern Ireland, United Kingdom
%A McCleane, Gary
%J J Palliat Med
%D 2007 Jun
%N 3
%P 798-805
%T Intravenous lidocaine: an outdated or underutilized treatment for pain?
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592992
%X Background: Conventional analgesic treatment involves the use of oral and transdermal formulations of drugs that require repetitive administration for sustained pain relief to be achieved. Along with the potential of analgesia, the risk of ongoing side effects consequent on the use of these analgesics also exists and this may have a detrimental effect on the patient's quality of life. In contrast, an intriguing body of evidence suggests that short-term administration of intravenous lidocaine may produce pain relief that far exceeds both the duration of infusion and the half-life of the drug. When pain relief is produced, concomitant analgesic medication can be reduced, side effects from pain relieving medication minimized with a potential for very real improvement in the quality of life of the patient. Objective: To ascertain whether literature evidence supports the use of intravenous lidocaine in clinical practice. Design: A review of the currently available published evidence. Results: A reasonable body of evidence, along with extensive clinical experience, suggests that intravenous lidocaine can have a useful pain-relieving effect and is worth consideration in palliative care patients. Conclusion: While this form of therapy is not commonplace in the terminally ill patient, it could be argued that its use has much merit in that field and should be considered

%0 Journal Article
%C Children's Hospital of Michigan, Detroit, Michigan 48201, USA. kmeert@med.wayne.edu
%A Meert, Kathleen L
%A Eggly, Susan
%A Pollack, Murray
%A Anand, K J S
%A Zimmerman, Jerry
%A Carcillo, Joseph
%A Newth, Christopher J L
%A Dean, J Michael
%A Willson, Douglas F
%A Nicholson, Carol
%J J Pediatr
%D 2007 Jul
%N 1
%P 50-5, 55.e1-2
%T Parents' perspectives regarding a physician-parent conference after their child's death in the pediatric intensive care unit
%V 151
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17586190
%X OBJECTIVE: To investigate parents' perspectives on the desirability, content, and conditions of a physician-parent conference after their child's death in the pediatric intensive care unit (PICU). STUDY DESIGN: Audio-recorded telephone interviews were conducted with 56 parents of 48 children. All children died in the PICU of one of six children's hospitals in the National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) 3 to 12 months before the study. RESULTS: Only seven (13%) parents had a scheduled meeting with any physician to discuss their child's death; 33 (59%) wanted to meet with their child's intensive care physician. Of these, 27 (82%) were willing to return to the hospital to meet. Topics that parents wanted to discuss included the chronology of events leading to PICU admission and death, cause of death, treatment, autopsy, genetic risk, medical documents, withdrawal of life support, ways to help others, bereavement support, and what to tell family. Parents sought reassurance and the opportunity to voice complaints and express gratitude. CONCLUSIONS: Many bereaved parents want to meet with the intensive care physician after their child's death. Parents seek to gain information and emotional support, and to give feedback about their PICU experience

%0 Journal Article
%A Meij, LW
%A Stroebe, M
%A Schut, H
%A Stroebe, W
%A den, JV
%A M, PG
%A Dijkstra, I
%J Br J Clin Psychol
%D 2007 Jun
%T Parents grieving the loss of their child: Interdependence in coping
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17588295
%X ObjectivesA longitudinal study was conducted among bereaved parents, to examine the relationship between parents' own and their partners' ways of coping in terms of the constructs loss-orientation and restoration-orientation (coping strategies based on the bereavement-specific Dual Process Model (Stroebe & Schut, 1999), and psychological adjustment following the death of their child.Method219 couples participated at 6, 13 and 20 months post-loss. Use of the Actor Partner Interdependence Model within multi-level regression analyses enabled assessment of both actor as well as partner effects, and permitted differentiating these effects according to the gender of the parent.ResultsLoss-orientation was predictive of negative psychological adjustment, while restoration-orientation was related to better adjustment. Furthermore, high levels of restoration-oriented coping buffered the negative effect of high levels of loss-orientation on depression. In the interpersonal context, results indicated that for men, having a female partner high in restoration-oriented coping was related to positive adjustment.ConclusionIn coping with the loss of their child, intra-personal as well as interpersonal processes are relevant for the adjustment process of parents after the loss of their child

%0 Journal Article
%A Miller, Nigel
%J Vet Rec
%D 2006 Apr
%N 13
%P 454
%T Provisions for emergency slaughter of cattle
%V 158
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16582001

%0 Journal Article
%C Centro Universitirio UNIVATES, Lajeado, RS. claudiasilva@futurusnet.com.br
%A Moraes e Silva, Claudia Adriana
%A Brunetto Verruckacker, Justina Ines
%J Rev Bras Enferm
%D 2007 Mar-Apr
%N 2
%P 150-4
%T [Palliative home care in the view of families of a person with neoplasia]
%V 60
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17585519
%X This is a qualitative research that aimed at knowing how the subject's family experiences palliative care in home for people with neoplasia. We have used a semi-structural interview for data collection. There were eight practitioners taking care of regional oncology service subjects. Data were analysed through Bardin's content analysis and refer to description of reasons, meanings, and difficulties experienced by the family in home care. We have found the most significant experiences were associated to what made women develop this care, this experience is related to economic difficulties and feelings of gratitude, fondness, love, feedback, fear, blame and conflicts

%0 Journal Article
%A Nau, Jean-Yves
%J Rev Med Suisse
%D 2007 Mar
%N 104
%P 836
%T [Euthanasia and physician-assisted suicide: confusion in France ]
%V 3
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17503725

%0 Journal Article
%C Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY
%A Neria, Y
%A Gross, R
%A Litz, B
%A Maguen, S
%A Insel, B
%A Seirmarco, G
%A Rosenfeld, H
%A Suh, EJ
%A Kishon, R
%A Cook, J
%A Marshall, RD
%J J Trauma Stress
%D 2007 Jun
%N 3
%P 251-262
%T Prevalence and psychological correlates of complicated grief among bereaved adults 2.5-3.5 years after September 11th attacks
%V 20
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17597124
%X A Web-based survey of adults who experienced loss during the September 11, 2001, terrorist attacks was conducted to examine the prevalence and correlates of complicated grief (CG) 2.5-3.5 years after the attacks. Forty-three percent of a study group of 704 bereaved adults across the United States screened positive for CG. In multivariate analyses, CG was associated with female gender, loss of a child, death of deceased at the World Trade Center, and live exposure to coverage of the attacks on television. Posttraumatic stress disorder, major depression, anxiety, suicidal ideation, and increase in post-9/11 smoking were common among participants with CG. A majority of the participants with CG reported receiving grief counseling and psychiatric medication after 9/11. Clinical and policy implications are discussed

%0 Journal Article
%C Dipartimento di Scienze Mediche Veterinarie, Facolta di Medicina Veterinaria, Universita degli Studi, 98168 Messina, Italy. passanna@unime.it
%A Passantino, Annamaria
%A Fenga, Carmela
%A Morciano, Cristina
%A Morelli, Chiara
%A Russo, Maria
%A Di Pietro, Carlotta
%A Passantino, Michele
%J Ann Ist Super Sanita
%D 2006 
%N 4
%P 491-5
%T Euthanasia of companion animals: a legal and ethical analysis
%V 42
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17361075
%X In Italy, the conditions under which euthanasia of small pets is justified are only partially regulated by law n. 281/1991, article 2 n. 6 and 9, by the later Ministry Circular n. 9 made on 10/03/1992 and by law n. 189/2004. Law n. 281/1991, besides delegating the job of birth control in cat and dog populations to the regions, has made it statutory that stray dogs may only be euthanised when they are 'seriously or incurably ill or proven to be dangerous'. The Ministry Circular underlines the fact that 'euthanasia of dogs is prohibited except in special justified cases'. On the other hand, due to the legal classification of animals as property, the owner has the right of ownership over his animal so that he can sell it and kill it (ius vitae ac necis). In this view a request for euthanasia is licit, whatever the animal's state of health may be. The authors feel that further legislation to regulate the question more completely would be opportune and thus they analyse the problems of legal-ethics and public health that a veterinarian faces when carrying out euthanasia, also bearing in mind the laws and codes of professional ethics. They suggest possible solutions which could be adopted by the competent authorities

%0 Journal Article
%C Hartford Hospital, Connecticut, USA
%A Peruta, Colleen M
%J RN
%D 2007 May
%N 5
%P 44-8
%T A change of heart: my experience with family presence
%V 70
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17547341

%0 Journal Article
%C Finlandia University, Michigan, USA. gladys.polzien@finlandia.edu
%A Polzien, Gladys
%J Home Healthc Nurse
%D 2007 May
%N 5
%P 335-8; quiz 339-40
%T Veterans' healthcare concerns: hepatitis C
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17495564

%0 Journal Article
%C Department of Medicine, University of California, San Francisco, San Francisco, California
%A Rabow, Michael
%A Gargani, John
%A Cooke, Molly
%J J Palliat Med
%D 2007 Jun
%N 3
%P 759-69
%T Do As I Say: Curricular Discordance in Medical School End-of-Life Care Education
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592988
%X Purpose: Prior research indicates that medical students face significant personal and ethical challenges when they perceive differences between what is taught in class (formal curriculum) and what is practiced on the wards (informal curriculum). This study seeks to further describe the educational experience and characteristics of students who perceive curricular discordance in end-of-life care (EOLC) training. Method: Self-administered questionnaire among third-year medical students at a large, urban medical school. Statistics to identify the correlates of perceived curricular discordance. Results: Completed surveys were returned by 141 students out of a class of 162 (response rate 86.5%). Student perception of curricular discordance was inversely correlated with student perception of educational quality (p = 0.001) and their regard for institutional values (p < 0.001). Student attitudes and emotional reactions did not correlate with curricular discordance, nor did student age, gender, ethnicity, or prior personal experience with death of a loved one. Students had limited role modeling and feedback. While student informal curricular experiences did not correlate with a perception of curricular discordance, an increased number of informal curricular EOLC experiences did correlate with a perception of poorer educational quality (p = 0.05). Conclusion: Curricular discordance is correlated with a perception of poorer educational quality and more negative regard for institutional EOLC values, but not correlated with other features of student experience or characteristics. Importantly, increased informal EOLC experiences are associated with a more negative assessment of educational quality

%0 Journal Article
%C LDS Hospital, Heart Failure Prevention and Treatment Program, Salt Lake City, UT, USA
%A Rasmusson, Kismet D
%A Hall, Jill A
%A Renlund, Dale G
%J Nurs Manage
%D 2007 May
%N 5
%P 33-40; quiz 40-1
%T The intricacies of heart failure
%V 38
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17486012

%0 Journal Article
%C Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Department of Medicine, Dalhousie University, Room 460, Bethune Building, 1278 Tower Road, Halifax, Nova Scotia, Canada B3H 2Y9. daniel.rayson@cdha.nshealth.ca
%A Rayson, Daniel
%A McIntyre, Paul
%J Curr Oncol Rep
%D 2007 Jul
%N 4
%P 285-9
%T Transitions to palliation: two solitudes or inevitable integration?
%V 9
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17588353
%X As options for systemic therapy for cancer continue to expand and median survival for many solid tumors lengthens, the divisions between active oncologic and palliative care continue to blur. Despite the well-recognized need to integrate palliative support for those with metastatic cancer, data on best practices facilitating the transition from active oncologic to active palliative care are lacking. Recent evidence outlining evolving issues surrounding this transition in care is reviewed, emphasizing the need for rigorous research efforts to define best practices and interventions

%0 Journal Article
%C Department of Palliative Care, Hope Healthcare, Braeside Hospital, Sydney, New South Wales, Australia
%A Rhee, Charles
%A Broadbent, Andrew Mark
%J J Palliat Med
%D 2007 Jun
%N 3
%P 677-85
%T Palliation and liver failure: palliative medications dosage guidelines
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592979
%X Palliation of symptoms is important in a variety of conditions, both malignant and nonmalignant. These symptoms may be present in patients with chronic or acute liver failure. However, to date there is a notable lack of reliable information on the use of medications that are commonly required in the palliative care of these patients. To facilitate care, a literature review was conducted with extensive searches of MEDLINE and Micromedex as well as reviews of the major textbooks of pharmacology, palliative care, gastroenterology and hepatology. A table is presented that includes medications organized in groupings of functional importance in palliative medicine such as opioids, antiarrhythmics, antidepressants, aperients, and other medications as selected for use at a Sydney palliative care unit. Data have been collected on the pharmacologic half-life in normal liver function and in cirrhosis. The latter, where suitable data could be obtained, were divided into three subgroups, using the Child-Pugh criteria. The further development of this information may help limit difficulties in choice of medication and reduce potential complications and improve palliation

%0 Journal Article
%C Division of Respirology, QEII Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada., Division of Palliative Medicine, QEII Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
%A Rocker, Graeme M
%A Sinuff, Tasnim
%A Horton, Robert
%A Hernandez, Paul
%J J Palliat Med
%D 2007 Jun
%N 3
%P 783-97
%T Advanced chronic obstructive pulmonary disease: innovative approaches to palliation
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592991
%X By the year 2020, chronic obstructive pulmonary disease (COPD) will be the third leading cause of death globally. While there have been consistent calls for increased palliative care involvement in the care of patients with advanced COPD, these calls should be based on empirical evidence that such an approach improves the symptom burden and poor quality of life associated with advanced COPD. Rather than reviewing the traditional treatments of airflow obstruction and palliative measures familiar to the palliative care community, we will focus on some novel approaches to the management of patients with advanced COPD from the perspective of clinicians involved in end of life care provision and research. By combining the clinical and research skills of pulmonologists and palliative medicine specialists we can advance the care of patients with this progressive and incurable disease

%0 Journal Article
%C excelleRx, Inc., An Omnicare Company, Philadelphia, Pennsylvania
%A Scarpaci, Laura T
%A Tsoukleris, Mona G
%A McPherson, Mary Lynn
%J J Palliat Med
%D 2007 Jun
%N 3
%P 665-76
%T Assessment of hospice nurses' technique in the use of inhalers and nebulizers
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592978
%X Dyspnea, a common distressing end-of-life symptom, is treated with oral (i.e., opioids and anxiolytics) and inhaled medications (anti-inflammatory and bronchodilator agents). Health care providers and patients have demonstrated an inability to use inhaler devices correctly, which can lead to suboptimal drug delivery and poor symptom relief. Hospice nurses are the primary health care providers educating patients, making it critical that they convey accurate device technique. This study assessed hospice nurses' ability to demonstrate proper inhaler device technique and their knowledge of agents used to treat dyspnea. Forty-seven nurses participated. Participants completed a written questionnaire, which gathered demographic data, as well as information regarding previous training with an inhaler device, administration, pharmacokinetics, mechanism of action, patient assessment, and nursing technique. Additionally, each nurse demonstrated the use of a metered dose inhaler, spacer, dry powder inhaler, and a nebulizer, while being observed by a pharmacist trained in the use of inhalers. A standardized evaluation form was used to ensure consistency between evaluators and subjects. Percentage of steps completed correctly by the study participants ranged from 34.9% with the dry powder inhaler to 67.6% with the metered dose inhaler. Years of experience, presence of hospice certification, personal use of inhaler, and nursing comfort level significantly impacted ability to use inhalation devices. This study demonstrated the existence of knowledge gaps regarding patient assessment, pharmacology and pharmacokinetics of inhaled medications, and inhalation device technique among hospice nurses. Formal education of hospice practitioners regarding inhaled medications and inhalation delivery devices is needed

%0 Journal Article
%C Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center and the Weil School of Medicine of Cornell University, 1275 York Avenue, New York, NY 10021, USA. shah1@mskcc.org
%A Shah, Manish A
%J Curr Oncol Rep
%D 2006 May
%N 3
%P 183-91
%T Gastric cancer: an update
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16618382
%X Gastric cancer is an aggressive malignancy, which, if metastatic or unresectable, is incurable. However, with metastatic or unresectable disease, patients receive a palliative benefit from chemotherapy. Although the understanding of the biology of this disease is increasing, the development of biologically targeted therapies for gastric cancer has been limited. Cytotoxic therapy remains the standard approach, and although there is agreement on the active agents and active combination chemotherapy regimens, consensus on the standard or reference regimen is lacking. This article reviews the pathophysiology of this disease, placing it in the context of its epidemiology, and the current advances in the treatment of this disease

%0 Journal Article
%A Silver, Roxane Cohen
%A Wortman, Camille B
%J JAMA
%D 2007 Jun
%N 24
%P 2692; author reply 2693-4
%T The stage theory of grief
%V 297
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17595266

%0 Journal Article
%A Sladek, RM
%A Tieman, J
%A Currow, D
%J BMC Med Inform Decis Mak
%D 2007 Jun
%N 1
%P 18
%T Improving search filter performance: a study of palliative care literature
%V 7
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17597549
%X ABSTRACT: BACKGROUND: It is difficult to systematically search for literature relevant to palliative care in general medical journals. A previously developed search filter for use on OVID Medline validated using a gold standard set of references identified through hand searching, achieved an unacceptably low sensitivity (45.4%). Retrieving relevant literature is integral to support evidence based practice, and understanding the nature of the incorrectly excluded citations (false negatives) using the filter may lead to improvement in the filter's performance. METHODS: The objectives were to describe the nature of subjects reflected in the false negative citations and to empirically improve the sensitivity of the search filter. A thematic analysis of MeSH terms by three independent reviewers was used to describe the subject coverage of the missed records. Using a frequency analysis of MeSH terms, those headings which could individually contribute at least 2.5% to sensitivity (occurring 19 or more times) were added to the search filter. All previously run searches were rerun at the same time as the revised filter, and results compared. RESULTS: Thematic analysis of MeSH terms identified thirteen themes reflected in the missing records, none of them intrinsically palliative. The addition of six MeSH terms to the existing search filter (physician-patient relations, prognosis, quality of life, survival rate, treatment outcome and attitude to health) led to an increase in sensitivity from 46.3% to 64.7%, offset by a decrease in precision from 72.6% to 21.9%. CONCLUSIONS: The filter's sensitivity was successfully increased using frequency analysis of MeSH terms, offset by a decrease in precision. A thematic analysis of MeSH terms for the false negative citations confirmed the absence of any intrinsically palliative theme or term, suggesting that future improvements to search filters for palliative care literature will first depend on better identifying how clinicians and researchers conceptualise palliative care. It is suggested that a constellation of parameters: stage of disease (advanced or active), prospect of cure (little or none), and treatment goals (primarily quality of life) may ultimately inform search strategies. This may be similarly true for chronic diseases, which share the inherent passage of time which marks them apart from acute, and therefore more readily identifiable, episodes of care

%0 Journal Article
%C Harvard Medical School, Boston, Massachusetts
%A Sweeney, Michael O
%A Quill, Timothy E
%J Heart Rhythm
%D 2007 Jul
%N 7
%P 952-5
%T Clustering of sudden death and aborted cardiac arrest associated with a family grief reaction
%V 4
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17599684

%0 Journal Article
%C Princess Margaret Hospital, University of Toronto, 5th Floor, 610 University Avenue, M5G 2M9, Toronto, Ontario, Canada
%A Sze, Jacqueline
%A Marisette, Stephen
%A Williams, Diane
%A Nyhof-Young, Joyce
%A Crooks, Dauna
%A Husain, Amna
%A Bezjak, Andrea
%A Wong, Rebecca K S
%J Support Care Cancer
%D 2006 Oct
%N 10
%P 1055-63
%T Decision making in palliative radiation therapy: reframing hope in caregivers and patients with brain metastases
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16502003
%X GOALS OF WORK : To explore the major factors important in decision making for whole-brain radiotherapy (WBRT) for patients with brain metastases and their caregivers. PATIENTS AND METHODS : Two parallel qualitative studies, one for patients and one for caregivers of patients with newly diagnosed brain metastases, were conducted. Semistructured interviews were conducted and audiotaped with each participant. Content analysis and theme extraction of the transcripts were undertaken to identify recurring themes and relational patterns. RESULTS : Twenty patients and 19 caregivers (including eight patient and caregiver pairs) were recruited into the study. Four major factors were identified to influence decision making of whole-brain radiation: hope, knowledge, expectations of radiation therapy, and current symptoms. Analysis reveals that patients generally focus on current informational needs, while caregivers want more information about the future (e.g., life expectancy and anticipated symptoms). Caregivers expressed frustration when unable to explore future needs because patients were unprepared to discuss prognostic issues. Participants expressed substantial relief when offered WBRT after the diagnosis, but WBRT is often considered the only available plan rather than an informed choice. CONCLUSIONS : Given the importance of caregivers in the care of patients with brain metastases, fulfilling their unique informational needs appears to require more attention. The blurred boundary between hopes and expectations for WBRT creates unique challenges in joint treatment decision making for patients with brain metastases and their caregivers

%0 Journal Article
%C Terry Sanford Institute of Public Policy, Duke University Durham, Durham, NC, USA
%A Taylor, DH Jr
%A Ostermann, J
%A Van, Houtven CH
%A Tulsky, JA
%A Steinhauser, K
%J Soc Sci Med
%D 2007 Jun
%T What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17600605
%X Hospices have been expected to reduce health expenditures since their addition to the US Medicare benefit package in the early-1980s, but the literature on their ability to do so is mixed. The contradictory findings noted in previous studies may be due to selection bias and the period of cost comparison used. Accounting for these, this study focuses on the length of hospice use that maximizes reductions in medical expenditures near death. We used a retrospective, case/control study of Medicare decedents (1993-2003, National Long Term Care Survey screening sample) to compare 1819 hospice decedents, with 3638 controls matched via their predicted likelihood of dying while using a hospice. Variables used to create matches were demographic, primary medical condition, cost of Medicare financed care prior to the last year of life, nursing home residence and Medicaid eligibility. Hospice use reduced Medicare program expenditures during the last year of life by an average of $2309 per hospice user; expenditures after initiation of hospice were $7318 for hospice users compared to $9627 for controls (P<0.001). On average, hospice use reduced Medicare expenditures during all but 2 of hospice users' last 72 days of life; about $10 on the 72nd day prior to death, with savings increasing to more than $750 on the day of death. Maximum cumulative expenditure reductions differed by primary condition. The maximum reduction in Medicare expenditures per user was about $7000, which occurred when a decedent had a primary condition of cancer and used a hospice for their last 58-103 days of life. For other primary conditions, the maximum savings of around $3500 occurred when a hospice was used for the last 50-108 days of life. Given the length of hospice use observed in the Medicare program, increasing the length of hospice use for 7 in 10 Medicare hospice users would increase savings

%0 Journal Article
%C Welsh Centre for Learning Disabilities, Centre for Health Sciences Research, Cardiff University, Cardiff, UK
%A Todd, S
%J J Intellect Disabil Res
%D 2007 Aug
%N Pt 8
%P 637-48
%T Silenced grief: living with the death of a child with intellectual disabilities
%V 51
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17598877
%X Background This paper examines the bereavement experiences of parents of people with intellectual disabilities (IDs). It is based upon an understanding that there exists little research-based understanding of those experiences or of the support needs of parents after the death of their child. Methods In-depth interviews were held with 13 parents on the deaths of their children with IDs. Results The data highlighted the deep sense of loss that these parents experience after the death of their child. The loss was intensely felt. They also show that their loss was a form of compounded loss. To begin with the scale and depth of loss is misrecognized. They also lose contact with a world that they had previously been heavily involved in. There was a sense that ID services and professionals withdrew from the family with too much haste. The data reveal that there exists no adequate supportive emotional community for these parents to express their grief. Conclusions It is argued that the experiences of these parents have much in common with understandings of disenfranchised grief. The implications of these findings for research and practice are briefly discussed

%0 Journal Article
%C Department of Geriatrics, New Hyde Park, New York., North Shore-Long Island Jewish Health System, New Hyde Park, New York
%A Wallace, Mervin P
%A Weiner, Joseph S
%A Pekmezaris, Renee
%A Almendral, Alicia
%A Cosiquien, Reginald
%A Auerbach, Charles
%A Wolf-Klein, Gisele
%J J Palliat Med
%D 2007 Jun
%N 3
%P 721-7
%T Physician cultural sensitivity in african american advance care planning: a pilot study
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17592984
%X Background: Physician cultural sensitivity is particularly important for end-of-life care. This study correlates physicians' own racial background, clinical experience, and cultural sensitivity training with their attitudes, perceptions, and knowledge of advance care planning issues for African American patients. Methods: A cross-sectional self-report questionnaire was distributed to 236 physicians at three major teaching hospitals. Results: Seventy-eight percent of all surveys were returned (183/236). The respondent racial characteristics were 53% white, 28% Asian, and 17% black. While 72% of physicians agreed that different ethnic groups have distinct attitudes towards advance directives, 58% acknowledged lack of familiarity with end-of-life preferences of African American patients. Black physicians (African American and non-U.S.-born) rated the cultural sensitivity training they received on a 0-10 Likert-type scale as 5.43 (n = 28) versus a 3.74 rating by white physicians (n = 91; p = 0.022). Black physicians (African American and non-U.S.-born, n = 27) rated their familiarity with advance care planning preferences of African Americans as 5.89 and white physicians (n = 90) rated theirs as 4.14 on a 10-point Likert-type scale (p = 0.002). Finally, 88% of U.S.-born black physicians (7/8) versus 35% of white physicians (32/91) perceived that the Tuskegee experiment has impacted African American medical decision-making (p = 0.014). Similarly, a greater proportion of African American physicians perceived that the Tuskegee experiment has impacted African American medical decision making, compared to non-U.S.-born black physicians (88% (7/8) versus 26% (5/19), p = 0.008). Conclusion: The majority of the physicians surveyed routinely provide end-of-life care and believe they are aware of racial differences in advance care planning. Yet, most were unfamiliar with specific end-of-life preferences of African American patients. We advocate for further research and cultural sensitivity training to improve end-of-life care for African American patients

%0 Journal Article
%A Weiner, Joseph S
%J JAMA
%D 2007 Jun
%N 24
%P 2692-3; author reply 2693-4
%T The stage theory of grief
%V 297
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17595265

%0 Journal Article
%C Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., 9116A, La Jolla, CA 92093, USA
%A Zisook, Sidney
%A Shear, Katherine
%A Kendler, Kenneth S
%J World Psychiatry
%D 2007 Jun
%N 2
%P 38-43
%T Validity of the bereavement exclusion criterion for the diagnosis of major depressive episode
%V 6
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17599191
%X Since the publication of DSM-III in 1980, the official position of American psychiatry has been that the presence of bereavement is an exclusion criterion for the diagnosis of a major depressive episode (MDE). However, the empirical validity of this exclusion has not been well established. As DSM-V is now being planned, it is timely to reexamine the bereavement exclusion, particularly in the light of new evidence since the last reviews of this subject. This paper evaluates the relative validity of two competing hypotheses: 1) the bereavement exclusion for the diagnosis of MDE is not valid because, using validating criteria, bereavement related depression (BRD) within the first two months after the death of a loved one resembles non-bereavement related depression (SMD); 2) the bereavement exclusion for the diagnosis of MDD is valid because, using validating criteria, BRD within the first two months after the death of a loved one does not resemble SMD. The prevailing evidence more strongly supports Hypothesis 1 than Hypothesis 2. Thus, the bereavement exclusion for the diagnosis of MDE may no longer be justified